Hurt or Injured?

Abstract

Adolescents are more vulnerable to concussion consequences due to disturbance of physiologic processes during brain maturation. Reports suggest up to 50% of adolescents do not seek healthcare post-sport related concussion (SRC). Failure to report results in treatment delays and leads to premature return to activities, potentiating risk for prolonged symptoms or subsequent injury. PURPOSE: The purpose of this study was to explore influential factors and pivotal decision points within adolescent athletes health decision-making (DM) process to seek healthcare post-SRC. METHODS: Grounded theory, a qualitative interpretation of participants’ words rather than statistical analysis, was used to examine salient concepts within athletes’ DM process. Twelve adolescent athletes representing several sports were recruited to participate in semi-structured interviews to describe their SRC experience. RESULTS: SRC DM occurred within context of sport culture encouraging to “push through pain.” The central perspective, known as the Dark Cloud, reflects literal and symbolic facets of SRC before and after the point of impact. Participants distinguished between hurt or injured, influencing symptom reporting. Athletes made sense of symptoms through crucial conversation with a trusted person to weigh options about concussion reporting. Participants who continued play with symptoms described prolonged cognitive and physical impairment, depression and anxiety. Individual, social, community, and policy factors influenced adolescent athletes’ SRC DM. CONCLUSIONS: Symptom reporting and connection with healthcare providers were influenced by the dark cloud of concussion. The Dark Cloud reflected factors before and after the point of impact. These factors ranged from blackouts, a dark room to avoid light and sensory stimulation, isolation from social support and physical activities, clouded judgment, foggy thoughts, dark mood and being in the dark about SRC symptoms. Athletes distinguished between the concept of injured versus hurt, with injury interfering with an athlete’s ability to participate in athletics, whereas an athlete may continue play while hurt. The distinction between hurt and injured was crucial to understanding an athlete’s perception about continued participation after forceful impact(s).